=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013114941
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CINDY B SMITH M.S., L.P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2007
-----------------------------------------------------
Last Update Date | 03/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1728 S CARSON AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74119-4610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-816-1149
-----------------------------------------------------
Fax | 918-280-0310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1728 S CARSON AVE
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74119-4610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-816-1149
-----------------------------------------------------
Fax | 918-280-0310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 5282
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MS LPC UNDER SUP.
-----------------------------------------------------
License Number State |
-----------------------------------------------------